# AMBUSH PEDIATRICS AND FAMILY MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ambush Pediatrics and Family MedicaL Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457956948
- **Authorized official:** DR. JACQUELINE EBONY AMBUSH DNP (OWNER/OPERATOR)
- **Authorized official phone:** (410) 707-5947

## Contact information

- **Practice address:** 4367 HOLLINS FERRY RD STE 1C, HALETHORPE, MD 21227-3400
- **Practice address phone:** (410) 609-6677
- **Practice address fax:** (410) 609-6672
- **Mailing address:** 4367 HOLLINS FERRY RD STE 1C, HALETHORPE, MD 21227-3400
- **Mailing address phone:** (410) 609-6677
- **Mailing address fax:** (410) 609-6672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | — | Yes |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/02/2020
- **Last updated:** 04/29/2026